Department of Emergency Medicine (CVK, CCM) and Department of Cardiology (CVK), Charité Universitiy Medicine, Berlin, Germany.
Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Clin Hemorheol Microcirc. 2020;76(3):413-423. doi: 10.3233/CH-200903.
Median arcuate ligament syndrome (MALS) is a rare condition due to compression of the celiac artery (CA) by an anatomically abnormal median arcuate ligament. With ultrasonography (US) as first-line diagnostic modality in patients with unclear abdominal pain, there is limited data on its diagnostic performance in MALS.
To investigate the value of CA peak systolic velocity (PSV) in the workup of patients with suspected MALS.
Patients with diagnosis of MALS between 2009 and 2019 were referred by Department of Visceral Surgery after clinical and gastroenterological workup. Diagnosis was confirmed by surgery or further cross-sectional imaging. B-mode US findings and PSV in the CA during various respiratory states were compared between patients with a final MALS diagnosis and patients not meeting the diagnostic criteria.
Patients with proven MALS (n = 10) had higher median CA PSV during normal inspiratory breath-hold (239 [IQR, 159-327] vs. 138 [IQR, 116-152] cm/s; p < #x003C;< #x200A;0.001), and expiratory breath-hold (287 [IQR, 191-412] vs. 133 [IQR, 115-194] cm/s; p < #x003C;< #x200A;0.001) compared to patients without MALS (n = 26). CA PSV in both inspiratory breath-hold (AUC 0.88, 95% CI 0.77-1.00) and expiratory breath-hold (AUC 0.89, 95% CI 0.78-1.00) was of diagnostic value for confirming MALS. The best diagnostic performance (100% sensitivity, 80% specificity) was found for the combination of CA PSVexpiration + 2.4 · PSVinspiration > 550 cm/s .
Since results on optimal cutoff values are inconsistent, a combination of CA PSVs during breathing maneuvers may help to diagnose or rule out MALS.
由于解剖异常的正中弓状韧带压迫腹腔动脉（CA），导致中位弓状韧带综合征（MALS）较为罕见。超声检查（US）作为不明原因腹痛患者的一线诊断方法，但其在 MALS 中的诊断性能数据有限。
探讨 CA 峰值收缩期速度（PSV）在疑似 MALS 患者检查中的价值。
2009 年至 2019 年间，内脏外科转介诊断为 MALS 的患者，经临床和胃肠病学检查后。通过手术或进一步的横断面成像来确认诊断。比较最终诊断为 MALS 的患者与不符合诊断标准的患者在各种呼吸状态下的 B 型 US 表现和 CA 中的 PSV。
10 例确诊为 MALS 的患者在正常吸气性屏气（239[IQR，159-327]cm/s 与 138[IQR，116-152]cm/s；p<#x003C;<#x200A;0.001）和呼气性屏气（287[IQR，191-412]cm/s 与 133[IQR，115-194]cm/s；p<#x003C;<#x200A;0.001）期间 CA PSV 更高，与无 MALS 的患者（n=26）相比。吸气性屏气（AUC 0.88，95%CI 0.77-1.00）和呼气性屏气（AUC 0.89，95%CI 0.78-1.00）时 CA PSV 均具有诊断价值，可用于确诊 MALS。CA PSV 呼气+2.4·PSV 吸气>550cm/s 的组合具有最佳的诊断性能（100%敏感性，80%特异性）。
由于最佳截断值的结果不一致，呼吸运动时 CA PSV 的组合可能有助于诊断或排除 MALS。
